Week 7 SAQ Electronic

MODULE 7 short answer questions.

Below are the module 7 SAQs. There are 10 SAQs so you have 60 minutes. Good luck!

Module 7 saQS

SAQ 1.

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An 85 year old female is found by the ambulance after not being seen for 24 hours. She has been found lying naked on her bathroom floor, with an altered level of consciousness. The ambulance report that the window was open and the shower was on.

Her arrival ECG is shown below.

Question 1.
What does the ECG show? Assume standard 25mm/s calibration. (4 marks)

Question 1. What does the ECG show? Assume standard 25mm/s calibration. (4 marks) *

Question 2.
What is the differential diagnosis? (3 marks)

Question 2. What is the differential diagnosis? (3 marks) *

Question 3.
List 6 investigations you will perform on this patient and the indication for each.

Question 3. List 6 investigations you will perform on this patient and the indication for each. *

SAQ 2.

A 17 year old male is brought to your emergency department during winter. The local river has frozen over. The patient had been drinking at the local pub with friends and dived off a bridge into the river. He ran into trouble, and had a prolonged immersion time. There is no overt trauma.

On arrival the patient’s vital signs are:

HR            46
BP            85/45
RR            12
Sats         99%
T                28.6 oC

Question 1.

Give three principles you will apply to your management of this patient, and the rationale for each. (6 marks)

Question 1. Give three principles you will apply to your management of this patient, and the rationale for each. (6 marks) *

Question 2.

Give 5 methods of rewarming this patient. (5 marks)

Question 2. Give 5 methods of rewarming this patient. (5 marks) *

Question 3.

Give two criteria for calling off cardiac resuscitation in a hypothermic patient?

Question 3. Give two criteria for calling off cardiac resuscitation in a hypothermic patient? *

SAQ 3

Question 1. (9 marks)

For each of the following hypothermic syndromes, give the relevant core body temperature range at which they occur, the main clinical features, and the cardiac specific features:

1. MILD HYPOTHERMIA
2. MODERATE HYPOTHERMIA
3. SEVERE HYPOTHERMIA

Question 1. (9 marks) For each of the following hypothermic syndromes, give the relevant core body temperature range at which they occur, the main clinical features, and the cardiac specific features: 1. MILD HYPOTHERMIA 2. MODERATE HYPOTHERMIA 3. SEVERE HYPOTHERMIA *

Question 2. (2 marks)

Give 2 methods of invasive temperature monitoring which can be used in the emergency department. (1 mark)

Question 2. (2 marks) Give 2 methods of invasive temperature monitoring which can be used in the emergency department. (1 mark) *

SAQ 4

A 92 year old female is brought into the emergency department after being found unconscious by her neighbour. She was last seen 36 hours previously.

On arrival in the ED it is noted that she is asystolic, and CPR is commenced. Her temperature is noted to be 31oC and her pupils are fixed and dilated.

An urgent arterial blood gas is taken via femoral stab during the initial phase of the resuscitation and results are shown below.

pH                              7.02
PO2 25            mmHg
PCO2 88            mmHg
HCO3- 2               mmol/L
Lactate 10.6        mmol/L

Na+                            141         mmol/L
K+                               10.2        mmol/L
Cl-                              100         mmol/L

Question 1.

What are the major abnormalities? (5 marks)

Question 1. What are the major abnormalities? (5 marks) *

Question 2. (1 mark)

What is the anion gap?

Question 2. (1 mark) What is the anion gap? *

Question 3. (2 marks)

What management will you institute?

Question 3. (2 marks) What management will you institute? *

Question 4. (2 marks)

A member of your team objects to cessation of resuscitation on the basis of the patient’s temperature, suggesting that the patient should be actively rewarmed before she can be pronounced dead. How will you respond?

Question 4. (2 marks) A member of your team objects to cessation of resuscitation on the basis of the patient’s temperature, suggesting that the patient should be actively rewarmed before she can be pronounced dead. How will you respond? *

SAQ 5

A 28 year old female is brought to your emergency department after being run over by a motorbike. There is no suggestion of a head or chest injury, and she has tire marks on her abdomen. A pelvic binder is in situ, and there are no long bone fractures or external sites of compressible haemorrhage. The injury occurred 40 minutes prior to arrival in the ED.

Her vital signs are:

HR 136 /min
BP 85/68 mmHg
RR 26 /min
Sats 99% RA
T 35.6 oC

A venous gas lactate on arrival is 4.6 mmol/L.

Question 1. (5 marks)

Give 5 interventions you will apply for the resuscitation of this patient.

Question 1. (5 marks) Give 5 interventions you will apply for the resuscitation of this patient. *

Question 2. (5 marks)

Give 5 clinical or laboratory endpoints you will assess as markers of the efficacy of your resuscitation.

Question 2. (5 marks) Give 5 clinical or laboratory endpoints you will assess as markers of the efficacy of your resuscitation. *

Question 3. (3 marks)

Briefly outline the evidence for the use of low blood pressure targets in trauma resuscitation.

Question 3. (3 marks) Briefly outline the evidence for the use of low blood pressure targets in trauma resuscitation. *

saq 6.

A 50 year old man is brought in by the ambulance after a VF cardiac arrest. The ambulance report 10 minutes of CPR at the scene followed by one successful 200J shock. The patient was unresponsive after this, so the intensive care paramedic present has performed an RSI with confirmed tube placement.

The patient's vital signs are:
HR 90
BP 95/66 mmHg
RR 16 (ventilated by BVM on 100% O2)
Sats 99%
T 37.3 oC

Question 1. (6 marks)

Give 3 initial investigations you will conduct in this patient and a rationale for each.

Question 1. (6 marks) Give 3 initial investigations you will conduct in this patient and a rationale for each. *

Question 2. (7 marks)

Give 7 strategies you will apply to facilitate effective ventilation and neuroprotection in this patient.

Question 2. Give 7 strategies you will apply to facilitate effective ventilation and neuroprotection in this patient. *

Question 3. (4 marks)

Summarise the evidence for the use of therapeutic hypothermia in this patient.

Question 3. (4 marks) Summarise the evidence for the use of therapeutic hypothermia in this patient. *

SAQ 7.

A 38 year old opiate overdose has been intubated by your registrar in the resus room for the purposes of airway protection. You have been called to see the patient as there is some difficulty with ventilation. The patient was intubated 15 minutes previously and the end tidal CO2 has continued to rise despite increasing the minute volume.

The patient’s vital signs are:

HR       118      /min
BP        120/83 mmHg
RR       ventilated at 20/min x 500ml TV
Sats     100%   30% O2
T          40.1     oC

Your registrar reports that the patient was intubated with succinyl choline 150mg and ketamine 150mg.

An arterial blood gas is shown below.

pH                    7.13
pO2                 149      mmHg
pCO2               56        mmHg
HCO3-              16        mmol/L

Na+                 140      mmol/L
K+                    6.8       mmol/L
Cl-                    104      mmol/L

Lactate 0.6       mmol/L

Question 1. (5 marks)

Describe two acid-base disturbances present in the gas above, calculate the expected compensatory response for each and comment on the results.

Question 1. (5 marks) Describe two acid-base disturbances present in the gas above, calculate the expected compensatory response for each and comment on the results. *

Question 2. (4 marks)

Give 2 calculated values that support your appraisal of the metabolic arm of the disturbance and comment on each.

Question 2. (4 marks) Give 2 calculated values that support your appraisal of the metabolic arm of the disturbance and comment on each. *

Question 3. (2 marks)

What is the most likely diagnosis?

Question 3. (2 marks) What is the most likely diagnosis? *

Question 4. (4 marks)

Give two pathology tests you will order to assess for complications of this condition, and the state the complication you are assessing for.

Question 4. (4 marks) Give two pathology tests you will order to assess for complications of this condition, and the state the complication you are assessing for. *

Question 5. (4 marks)

Give 4 management steps you will now undertake.

Question 5. (4 marks) Give 4 management steps you will now undertake. *

SAQ 8. (Note follows into saQ 9 as a double question).

A 19 year old male is brought into your department by ambulance with severe cramps in his arms and legs. He is alert and oriented, and has been brought in from running a 20km race.

His vital signs are:

HR       110                  /min
BP        88/66              mmHg
RR       33                    /min
Sats     99%                 RA
T          40.1                 oC

His venous gas on arrival is shown below.

pH                    7.15
pCO2               30        mmHg
PO2                 38        mmHg
HCO3-              15        mmol/L
BE                    -5

Na+                 140      mmol/L
K+                    7.1       mmol/L
Cl-                    107      mmol/L
Urea                15.6     mmol/L
Creatinine       300      umol/L

Question 1. (6 marks)

Give 3 acid base disturbances that are present, and indicate if each is primary or compensatory.

Question 1. (6 marks) Give 3 acid base disturbances that are present, and indicate if each is primary or compensatory. *

Question 2. (3 marks)

Provide 3 calculations to support your answer above.

Question 2. (3 marks) Provide 3 calculations to support your answer above. *

Question 3. (3 marks)

Give 3 other major abnormalities present on the pathology.

Question 3. (3 marks) Give 3 other major abnormalities present on the pathology. *

Question 4. (2 marks)

What is the likely cause of this patient’s illness? Provide a calculation to support your answer.

Question 4. (2 marks) What is the likely cause of this patient’s illness? Provide a calculation to support your answer. *

Question 5. (1 mark)

What further investigation will you add on to this patient’s pathology to confirm your diagnosis?

Question 5. (1 mark) What further investigation will you add on to this patient’s pathology to confirm your diagnosis? *

saq 9 (continues from saq 8).

The patient from SAQ 8 has an ECG, which is shown below.

Question 1.

Give 4 abnormalities seen on the ECG (4 marks)

Question 1. Give 4 abnormalities seen on the ECG (4 marks) *

Question 2. (4 marks)

Give 4 treatments you will specifically give in response to this ECG.

Question 2. (4 marks) Give 4 treatments you will specifically give in response to this ECG. *

Question 3. (6 marks)

The patient’s CK titre returns at 15 000 IU/L. List 3 therapeutic issues in this patient, and outline how you will treat each one.

Question 3. (6 marks) The patient’s CK titre returns at 15 000 IU/L. List 3 therapeutic issues in this patient, and outline how you will treat each one. *

Question 4. (4 marks)

List 4 methods you will use to begin cooling this patient.

Question 4. (4 marks) List 4 methods you will use to begin cooling this patient. *

saq 10.

Compare and contrast neuroleptic malignant syndrome and malignant hyperthermia, with regard to the following issues:

Causative agent and an example (4 marks)
Onset (2 marks)
Clinical features (3 each for 6 marks total)
Treatment principles (4 marks)

Compare and contrast neuroleptic malignant syndrome and malignant hyperthermia, with regard to the following issues: Causative agent and an example (4 marks) Onset (2 marks) Clinical features (3 each for 6 marks total) Treatment principles (4 marks) *

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